Bulletin No. 90-07

Interpretive statement issued pursuant to act 306 of the
public acts of 1969, as amended

The purpose of this bulletin is to explain to insurers the
provisions of Section 3475 of the Michigan Insurance Code, MCLA
500.3475. It has come to the attention of the Insurance Bureau
that confusion exists among insurers with regard to the meaning
of Section 3475. Specifically, complaints have been made regarding
coverage for chiropractic care.

Section 3475 of the Code states:

Notwithstanding any provision of any policy of insurance
or certificate, if an insurance policy or certificate provides
for reimbursement for any service which may be legally performed
by a person fully licensed as a psychologist under part 182
of the public health code, Act No. 368 of the Public Acts
of 1978, being sections 333.18201 to 333.18237 of the Michigan
Compiled Laws; by a podiatrist licensed under part 180 of
the public health code, Act No. 368 of the Public Acts of
1978, being sections 333.18001 to 333.18033 of the Michigan
Compiled Laws; by a chiropractor licensed under part 164 of
the public health code, Act No. 368 of the Public Acts of
1978, being sections 333.16401 to 333.16431 of the Michigan
Compiled Laws; reimbursement under the insurance policy or
certificate shall not be denied if the service is rendered
by a person fully licensed as a psychologist under part 182
of the public health code, Act No. 368 of the Public Acts
of 1978; by a podiatrist licensed under part 180 of the public
health code, Act No. 368 of the Public Acts of 1978; or by
a chiropractor licensed under part 164 of the public health
code, Act No. 368 of the Public Acts of 1978; within the statutory
provisions provided in his or her individual practice act.
This section shall not be construed as requiring the coverage
for a psychologist in any insurance policy. This section shall
not apply to a policy or certificate written pursuant to section
3405, 3631, or 3709 involving a prudent purchaser agreement.

INTERPRETIVE STATEMENT

The scope of professional services which are appropriately
performed by licensed podiatrists, psychologists or chiropractors
is defined by the Michigan Code of Public Health.

Under Section 3475, if a health or disability insurance policy
provides reimbursement for a service that may legally be performed
by a licensed podiatrist, psychologist, or chiropractor, then
reimbursement under the policy cannot be denied if the service
is in fact rendered by a licensed podiatrist, psychologist,
or chiropractor.

Further, defining the term "physician" so as to
exclude podiatrists, psychologists or chiropractors acting within
the scope of their professional license and limiting the number
of or maximum benefit for treatments or services performed by
podiatrists, psychologists or chiropractors while not placing
limits on the same treatments and services performed by other
practitioners would be improper under Section 3475.

Information regarding the scope of professional medical practice
may be obtained from the Podiatric Medicine and Surgery Board,
Psychology Board or Chiropractic Board at: